A comparison of the rates of and indications for cesarean delivery between Syrian refugee women and Turkish women

SUMMARY OBJECTIVE: The aim of this study was to compare the rates of and indications for cesarean delivery among Syrian refugee women and local Turkish women. METHODS: The study included 74,864 pregnant women, of whom 52,145 were Turkish and 22,719 were Syrian refugee women and who gave birth at our hospital between January 2013 and December 2021. In this study, the pregnant women were divided into two groups: Syrian refugee women and Turkish women, and primary cesarean delivery rates were calculated separately for each group. Cesarean delivery rates for Syrian refugee women and Turkish women were compared separately for each year. Indications for cesarean delivery were determined separately for each group and compared between the groups. RESULTS: The overall cesarean delivery rate was 56% among Turkish women and 32% among Syrian women (p<0.05). The primary cesarean delivery rate was 18.4% for local Turkish women versus 10.7% among Syrian refugee women (p<0.05). The most common indication for cesarean delivery among both Syrian refugee women and local Turkish women was previous cesarean delivery, followed by acute fetal distress and cephalopelvic disproportion. CONCLUSION: Indications for cesarean delivery were similar for Syrian refugee women and local Turkish women, but both overall and primary cesarean delivery rates were higher among local Turkish women compared with Syrian refugee women.

Focal increta placentomegaly of the posterior nonscarred uterine wall and posterior asynclitic presentation.

BACKGROUND: Fetal malpresentations and malpositions are more common in placenta previa and uterine cavity abnormalities. AIM: To show successful management of focal increta placentomegaly and uterine preservation in primiparous woman. CASE REPORT: We describe posterior low-lying focal increta placentomegaly verified during cesarean section, which is a possible risk factor for persistent posterior asynclitism and consequent mechanical dystocia. In addition to antifibrinolytics and uterotonics, hemostatic compression sutures of the posterior uterine wall were performed with an applied intrauterine balloon, and thus the uterus was preserved in primiparous woman as a definitive therapy. CONCLUSION: Timely identified malplacentation as well as adequate medical and surgical measures taken by an experienced team of obstetricians and anesthesiologists can contribute to preservation of the uterus and thus the life of mother and neonate.

Pregnant women's views on the acceptability, enablers, and barriers of participation in a randomized controlled trial of maternal posture for fetal malposition in labor.

INTRODUCTION: Fetal malposition in labor results in adverse maternal and infant health. Whilst evidence for effective interventions is inconclusive, based on the hypothesis that gravity corrects malposition, the feasibility and design of a randomized controlled trial (RCT) to improve maternal and infant health outcomes should be considered. The aim was to assess pregnant women's views on the acceptability, enablers, and barriers of participation in an RCT of maternal posture for fetal malposition in labor. METHODS: A web-based anonymous survey of pregnant women was conducted in Auckland during 2020. Quantitative data were summarized descriptively using a chi-squared test to assess differences in proportions. Maternal characteristics influence on women's responses was assessed using cross-tabulation. A thematic content analysis of free text responses was undertaken. RESULTS: Most of the 206 respondents were aged 26-35 years (75%), 29-38 weeks pregnant (71%), of European (40%) or Asian (36%) ethnicity, and similarly nulliparous or multiparous. Most women (76%) knew of fetal malposition in labor; however, only 28% were aware of maternal posture to correct this. Most women (86%) were interested in labor research and although 37% would participate in an RCT, almost half (47%) were unsure and a 15% would not participate. Concerns mostly related to comfort (22%). Nearly half of women (49%) would need to consult their partner regarding participation in an RCT. CONCLUSIONS: Enablers for participation in a posture trial in labor include measures to enhance maternal comfort, increasing awareness of malposition and the role of posture, and involving partners in pre-trial counselling and recruitment.

Escore de Apgar e indicação de cesárea por sofrimento fetal em um hospital público do Distrito Federal / Apgar score and indication of cesarean section due to fetal distress at a public hospital in the Federal District

Objetivo: Avaliar as indicações de cesárea por sofrimento fetal (SF), pelo escore de Apgar, em um hospital público. Métodos: Estudo de corte transversal e retrospectivo que incluiu todos os partos realizados no período de estudo. A análise estatística foi realizada no software IBM SPSS Statistics v.22 com teste do qui-quadrado de Pearson para o cálculo do p-valor. A estimativa de risco foi definida pela razão de chances comum de Mantel-Haenszel, com cálculo de odds ratio (OR), intervalo de confiança de 95% (IC95%) e limite de significância de 95% (p < 0,05). Resultados: Dos 2.205 partos, 1.084 (49,1%) foram cesáreas e 1.121 (50,9%), partos vaginais. Escore de Apgar < 7 no primeiro minuto foi evidenciado em 5,9% do total de partos. A diferença entre os escores de Apgar no primeiro minuto entre os dois tipos de parto foi estatisticamente significante (p < 0,05), e esses recém-nascidos (RNs) tiveram a chance 1,4 vez maior de Apgar < 7 nas cesáreas em relação ao parto vaginal (OR: 1,4; IC95%: 1-2,05). No quinto minuto, Apgar < 7 ocorreu em 0,7% em todos os tipos de partos. O SF foi a terceira causa de indicação de cesárea (22,8%), e o Apgar < 7 não diferenciou das cesáreas por demais causas. Conclusão: Este estudo demonstrou alta taxa de cesárea e maior risco de Apgar < 7 no primeiro minuto para esses partos. A ausência de diferença estatisticamente significante entre o Apgar dos RNs de cesárea por SF e demais indicações revela a necessidade local de rever esse diagnóstico e consequente conduta.(AU)

Objective: To evaluate the cesarean indications for fetal distress (FD), using the Apgar score, in a public hospital. Methods: Cross-sectional and retrospective study, which included all the deliveries performed during the period of study. Statistical Analysis was performed using the IBM SPSS Statistics v.22 software with Pearson's Chi-square test to calculate the p-value. The risk estimate for Apgar < 7 was defined by the common odds ratio (OR) of Mantel-Haenszel, with calculation of OR and 95% confidence interval and significance limit of 95% (p < 0.05). Results: Of the 2,205 deliveries, 1,084 (49.1%) were cesarean and 1,121 (50.9%) were vaginal deliveries. Apgar score < 7 in the 1st minute was seen in 5.9% of total deliveries. The difference between the Apgar Scores in the 1st minute between the two types of delivery was statistically significant (p < 0.05), and these newborns (NBs) had 1.4 times more chance of Apgar < 7 in cesarean in relation to vaginal delivery (OR: 1,4; IC95%: 1-2,05). In the 5th minute, Apgar < 7 occurred in 0.7% of all types of births. FD was the third cause of cesarean indication (22.8%) and the Apgar < 7 wasn't different from the cesareans performed for other causes. Conclusion: This study demonstrated a high cesarean rate and a bigger risk of Apgar < 7 in the 1st minute for this type of delivery. The absence of statistically significant difference between the Apgar of NBs of cesarean due to FD and other indications reveal the need to review this diagnosis e it's conduct.(AU)

Efetividade das essências florais no trabalho de parto e nascimento: avaliação dos parâmetros obstétricos e neuroendócrinos / Efectividad de las esencias florales en el trabajo de parto y nacimiento: evaluación de los parámetros obstétricos y neuroendócrinos / Effectiveness of flower essences in labor and birth: evaluation of obstetric and neuroendocrine parameters

Resumo Objetivo Avaliar a efetividade da terapia floral associados aos fatores que potencializam a dor e o estresse no processo de parturição por meio de parâmetros obstétricos e neuroendócrinos. Métodos Ensaio clínico randomizado, triplo cego, placebo controlado, realizado com 164 parturientes de risco obstétrico habitual, subdivididas entre dois grupos para as quais foram ministradas essência floral Five Flower e placebo, respectivamente. Avaliou-se aspectos obstétricos e neuroendócrinos por meio da análise bioquímica dos hormônios Beta-endorfina e Cortisol salivar antes e ao término da intervenção. Resultados A essência floral modulou os fatores que potencializam a dor no trabalho de parto, isto é, rotura das membranas amnióticas, fase ativa e indução do parto. Houve aumento dos níveis de Beta-endorfina juntamente com a diminuição de uma contração em mulheres com rotura das membranas ovulares e com indução. Em relação ao estresse, houve constância dos valores do Cortisol para o Grupo Experimental, não alterando seu valor na fase ativa, rotura das membranas ovulares ou indução. A Essência Five Flower mostrou-se eficaz na redução de uma hora e vinte e cinco minutos do tempo do trabalho de parto no Grupo Experimental. Conclusão A terapia floral realizada, mostrou-se eficaz no controle da dor e estresse durante o trabalho de parto, refletindo positivamente na sua brevidade e qualificando seu desfecho.

Resumen Objetivo Evaluar la efectividad de la terapia floral asociada a los factores que potencializan el dolor y el estrés en el proceso de parto por medio de parámetros obstétricos y neuroendócrinos. Métodos Ensayo clínico aleatorizado, triple ciego, placebo controlado, realizado con 164 parturientas de riesgo obstétrico normal, subdivididas en dos grupos en que se les administró esencia floral Five Flower y placebo. Se evaluaron aspectos obstétricos y neuroendócrinos por medio del análisis bioquímico de las hormonas betaendorfina y cortisol salival antes y al final de la intervención. Resultados La esencia floral reguló los factores que potencializan el dolor en el trabajo de parto, es decir, ruptura de las membranas amnióticas, fase activa e inducción del parto. Hubo aumento de los niveles de betaendorfina junto con la reducción de una contracción en mujeres con ruptura de las membranas ovulares y con inducción. Con relación al estrés, hubo constancia de los valores de cortisol en el grupo experimental, sin aumento de su valor en la fase activa, ruptura de las membranas ovulares o inducción. La esencia Five Flower demostró ser eficaz para la reducción de una hora y veinticinco minutos de tiempo de trabajo de parto en el grupo experimental. Conclusión La terapia floral realizada demostró ser eficaz en el control del dolor y del estrés durante el trabajo de parto, con un impacto positivo en su brevedad y en la cualificación de su desenlace.

Abstract Objective To evaluate the effectiveness of floral therapy associated with factors that strengthen pain and stress in the labor process through obstetric and neuroendocrine parameters. Methods Randomized, triple-blind, placebo-controlled clinical trial performed with 164 parturients at usual obstetric risk subdivided into two groups to which Five Flower floral essence and placebo were administered. Obstetric and neuroendocrine aspects were evaluated through biochemical analysis of the beta-endorphin and cortisol hormones through salivary samples before and after the intervention. Results The flower essence modulated the factors that strengthen pain in labor, that is, rupture of amniotic membranes, active phase and induction of labor. There was an increase in beta-endorphin levels along with one less contraction in women with ruptured ovular membranes and labor induction. Regarding stress, cortisol values were constant for the Experimental group, and did not change in the active phase, rupture of the ovular membranes or induction. The Five Flower essence proved to be effective in reducing labor time by 1 hour 25 minutes in the Experimental group. Conclusion The floral therapy used proved to be effective in controlling pain and stress during labor, and reflected positively on its agility and qualified its outcome.

Women's Selection of Mode of Birth for their Breech Presentation.

OBJECTIVE: Many studies since the Term Breech Trial have demonstrated the safety of vaginal breech birth (VBB), and today it is an option for breech presentation at term. However, women with breech presentation often face a difficult decision regarding mode of birth, especially when planned cesarean was the standard of care in the not-so-distant past. We aim to clarify the decision-making process and barriers women face when making this decision. METHODS: Between January and April 2016, women who delivered with breech presentation were approached during their postpartum hospital stay to obtain consent for the study. The follow-up, semi-structured interview probed the woman's acquisition of knowledge and supports and barriers to her choices leading up to delivery. The responses were recorded and transcribed for analysis, and themes were identified for reporting. RESULTS: Of the 95 women who completed the interview, 21 preferred VBB but only 1 had a VBB. Most unplanned cesarean deliveries were performed for obstetrical indications, but 5 women expressed a lack of support for VBB or did not recall being provided options. Themes were identified with respect to the influences the women experienced, including passive external, provider-based, evidence-based, and internal. CONCLUSION: Despite the availability of options for breech pregnancy, the majority of women continue to have planned cesarean deliveries. The retrospective process reveals that women did not fully understand the eligibility criteria for VBB and all available options (including external cephalic version). Shared decision-making and continuity of care should remain a priority during the counselling process and delivery of care.

Variables clínicas del parto en posición vertical y horizontal: revisión exhaustiva de literatura / Clinical Behavior of Vertical and Horizontal Deliveries: Exhaustive Literature Review / Variáveis clínicas do parto em posição vertical e horizontal: revisão abrangente de literatura

Introducción: El trabajo de parto representa el acontecimiento más importante durante la culminación del periodo de gestación y, por lo tanto, la adecuada elección de su posición, ya sea vertical u horizontal, resulta indispensable para minimizar las complicaciones maternas y neonatales. Objetivo: Llevar a cabo una revisión de la literatura sobre el comportamiento clínico del parto vertical y horizontal, describiendo los principales resultados en diferentes países del mundo. Método: Revisión documental mediante la búsqueda de la literatura entre 2009 y 2020 en bases de datos especializadas. Resultados: La posición vertical se asoció con una menor duración del trabajo de parto, dolor referido y necesidad de episiotomía; no obstante, esta posición puede incrementar el riesgo de hemorragia posparto y daño perineal. Conclusión: La variedad de desenlaces obstétricos y neonatales asociados a las posiciones de parto vertical y horizontal hacen complejo definir una posición de parto óptima; por lo tanto, se recomienda la libre elección de acuerdo con las características que presente cada paciente

Introduction: Parturition represents the most important event during the culmination of the gestation period and, therefore, the appropriate choice of its position, whether vertical or horizontal, it is essential to minimize maternal and neonatal complications. Objective: To carry out a review of the literature on the clinical behavior of vertical and horizontal delivery, describing the main results in different countries of the world. Method: Document review by searching the literature between the years 2009 and 2020, available in Specialized Databases. Results: The vertical position was associated with a shorter duration of labor obstetric, referred pain, and episiotomy; however, this position may increase the risk of postpartum hemorrhage and perineal damage. Conclusion: The variety of obstetric and neonatal outcomes associated with vertical and horizontal delivery positions make it difficult to define an optimal delivery position and, therefore, free choice is recommended according to the characteristics of each patient

Introdução: O trabalho de parto representa o acontecimento mais importante no final do período gestacional e, portanto, a escolha apropriada da posição, seja vertical ou horizontal, é indispensável para minimizar as complicações maternas e neonatais. Objetivo: Realizar uma revisão bibliográfica sobre o comportamento clínico do parto vertical e hori-zontal, descrevendo os principais resultados em diferentes países do mundo. Método: Revisão documental através de pesquisa da literatura em bases de dados especializadas entre os anos 2009 e 2020. Resultados: A posição vertical foi associada a uma duração mais curta do parto, dor referida e ne-cessidade de episiotomía; contudo, esta posição pode aumentar o risco de hemorragia pós-parto e dano perineal. Conclusão: A variedade de resultados obstétricos e neonatais associados às posições de parto vertical e horizontal torna complexa a escolha de uma posição de parto ótima; por conseguinte, recomen-da-se a livre escolha de acordo com as caraterísticas de cada paciente

Content validity of the nursing diagnosis powerlessness in women during natural childbirth / Validación de contenido del diagnóstico de enfermería sentimiento de impotencia en mujeres durante el parto normal / Validação de conteúdo do diagnóstico de enfermagem sentimento de impotência em mulheres durante o parto normal

ABSTRACT Objective: To validate the content of the nursing diagnosis powerlessness in women during natural childbirth. Method: A nursing diagnosis content validation, in which 29 experts analyzed the definition of powerlessness and assessed the relevance of related factors, populations at risk, associated conditions and defining characteristics. These elements were considered relevant when the Content Validity Index was greater than or equal to 0.9. Results: Experts considered the definition resulting from the concept analysis more appropriate for the diagnosis under study. Regarding the assessment of diagnostic elements, 10 related factors, two populations at risk, three associated conditions and 10 defining characteristics were considered relevant. Conclusion: The new definition for powerlessness and 25 elements have been validated by experts. These can support the operationalization of the Nursing Process for parturient women.

RESUMEN Objetivo: Validar el contenido del diagnóstico de enfermería sentimiento de impotencia en mujeres durante el parto normal. Método: Validación del contenido del diagnóstico de enfermería, en el que 29 expertos analizaron la definición del diagnóstico sentimiento de impotencia y evaluaron la relevancia de factores relacionados, poblaciones en riesgo, condiciones asociadas y características definitorias. Estos elementos se consideraron relevantes cuando el Índice de Validez de Contenido fue mayor o igual a 0,9. Resultados: Los expertos consideraron más adecuada la definición resultante del análisis de concepto para el diagnóstico en estudio. En cuanto a la evaluación de los elementos diagnósticos, se consideraron relevantes 10 factores relacionados, dos poblaciones en riesgo, tres condiciones asociadas y 10 características definitorias. Conclusión: La nueva definición del diagnóstico de enfermería sentimiento de impotencia y 25 elementos fueron validados por expertos. Estos pueden apoyar la operacionalización del proceso de enfermería para parturientas.

Objetivo: Validar o conteúdo do diagnóstico de enfermagem sentimento de impotência em mulheres durante o parto normal. Método: Validação de conteúdo de diagnóstico de enfermagem, no qual 29 especialistas analisaram a definição do diagnóstico sentimento de impotência e avaliaram a relevância dos fatores relacionados, populações em risco, condições associadas e características definidoras. Esses elementos foram considerados relevantes quando o Índice de Validade de Conteúdo foi maior ou igual a 0,9. Resultados: Os especialistas consideraram a definição resultante da análise de conceito mais apropriada para o diagnóstico em estudo. Em relação à avaliação dos elementos do diagnóstico, 10 fatores relacionados, duas populações em risco, três condições associadas e 10 características definidoras foram consideradas relevantes. Conclusão: A nova definição para o diagnóstico de enfermagem sentimento de impotência e 25 elementos foram validados pelos especialistas. Estes podem subsidiar a operacionalização do Processo de Enfermagem às parturientes.

Validation of a predictive model for successful vaginal birth after cesarean section.

INTRODUCTION: A strategy for reducing the number of cesarean sections is to allow vaginal delivery after cesarean section. OBJECTIVE: To validate two predictive models, Metz and Grobman, for successful vaginal delivery after a cesarean section. METHODS: Retrospective cohort study involving women with previous history of a previous segmental cesarean section, single pregnancy ≥37 weeks and cephalic presentation. The proportion of vaginal delivery in all pregnant women was determined, and it was compared with those (women) with successful delivery after cesarean section. Then, there were elaborated the models, and their predictive capacity was determined by curve-receiver-operator. RESULTS: The proportion of successful delivery in pregnant women with a previous cesarean section and indication of vaginal delivery was 85.64%. The observed proportion of birth for each decile predicted in the Grobman model was less than 15%, except for the 91-100% decile, where it was 64.09%; the area under the curve was 0.95. For the Metz model, the actual successful delivery rate was lower than predicted in scores between 4 and 14, and within expected for a score between 15 and 23; the area under the curve was 0.94. CONCLUSIONS: The vaginal delivery rate after cesarean was lower than expected according to the predictive models of Grobman and Metz. The implementation of these models in a prospective way can lead to a higher rate of successful birth.

INTRODUCCIÓN: Una estrategia de reducción del número de cesáreas es permitir el parto vaginal después de cesárea. OBJETIVO: Validar dos modelos predictivos, Metz y Grobman, para el parto vaginal exitoso después de una cesárea. MÉTODOS: Estudio de cohorte retrospectivo con mujeres con antecedente de una cesárea segmentaria previa, embarazo único ≥37 semanas y presentación cefálica . Se determinó la proporción de parto vaginal en todas las gestantes y se comparó con aquellas con parto exitoso después de cesárea, se elaboró los modelos y se determinó la capacidad predictiva de ellos mediante curva-receptor-operador. RESULTADOS: La proporción de parto exitoso en gestantes con cesárea previa e indicación de parto vaginal fue 85.64%. La proporción de parto observado para cada decil predicho en el modelo de Grobman fue inferior al 15%, excepto para el decil 91-100%, en el que fue 64.09%, el área bajo la curva fue 0.95. Para el modelo de Metz, la proporción de parto exitoso real fue menor a lo predicho en puntajes entre 4-14 y dentro de lo esperado para puntaje entre 15-23, con un área bajo la curva de 0.94. CONCLUSIONES: La tasa de parto vaginal después de cesárea fue menor a lo esperado de acuerdo a los modelos predictivos de Grobman y Metz. La implementación de estos modelos en forma prospectiva puede llevar una mayor tasa de parto exitoso.

Validation of a predictive model for successful vaginal birth after cesarean section / Validación de modelos predictivos para parto vaginal exitoso después de cesárea

Abstract Introduction: A strategy for reducing the number of cesarean sections is to allow vaginal delivery after cesarean section. Objective: To validate two predictive models, Metz and Grobman, for successful vaginal delivery after a cesarean section. Methods: Retrospective cohort study involving women with previous history of a previous segmental cesarean section, single pregnancy ≥37 weeks and cephalic presentation. The proportion of vaginal delivery in all pregnant women was determined, and it was compared with those (women) with successful delivery after cesarean section. Then, there were elaborated the models, and their predictive capacity was determined by curve-receiver-operator. Results: The proportion of successful delivery in pregnant women with a previous cesarean section and indication of vaginal delivery was 85.64%. The observed proportion of birth for each decile predicted in the Grobman model was less than 15%, except for the 91-100% decile, where it was 64.09%; the area under the curve was 0.95. For the Metz model, the actual successful delivery rate was lower than predicted in scores between 4 and 14, and within expected for a score between 15 and 23; the area under the curve was 0.94. Conclusions: The vaginal delivery rate after cesarean was lower than expected according to the predictive models of Grobman and Metz. The implementation of these models in a prospective way can lead to a higher rate of successful birth.

Resumen Introducción: Una estrategia de reducción del número de cesáreas es permitir el parto vaginal después de cesárea. Objetivo: Validar dos modelos predictivos, Metz y Grobman, para el parto vaginal exitoso después de una cesárea. Métodos: Estudio de cohorte retrospectivo con mujeres con antecedente de una cesárea segmentaria previa, embarazo único ≥37 semanas y presentación cefálica . Se determinó la proporción de parto vaginal en todas las gestantes y se comparó con aquellas con parto exitoso después de cesárea, se elaboró los modelos y se determinó la capacidad predictiva de ellos mediante curva-receptor-operador. Resultados: La proporción de parto exitoso en gestantes con cesárea previa e indicación de parto vaginal fue 85.64%. La proporción de parto observado para cada decil predicho en el modelo de Grobman fue inferior al 15%, excepto para el decil 91-100%, en el que fue 64.09%, el área bajo la curva fue 0.95. Para el modelo de Metz, la proporción de parto exitoso real fue menor a lo predicho en puntajes entre 4-14 y dentro de lo esperado para puntaje entre 15-23, con un área bajo la curva de 0.94. Conclusiones: La tasa de parto vaginal después de cesárea fue menor a lo esperado de acuerdo a los modelos predictivos de Grobman y Metz. La implementación de estos modelos en forma prospectiva puede llevar una mayor tasa de parto exitoso.

Malpresentation in low- and middle-income countries: Associations with perinatal and maternal outcomes in the Global Network.

INTRODUCTION: Uncertainty exists regarding the impact of malpresentation on pregnancy outcomes and the optimal mode of delivery in low- and middle-income countries. We sought to compare outcomes between cephalic and non-cephalic pregnancies. MATERIAL AND METHODS: Using the NICHD Global Network's prospective, population-based registry of pregnancy outcomes from 2010 to 2016, we studied outcomes in 436 112 singleton pregnancies. Robust Poisson regressions were used to estimate the risk of adverse outcomes associated with malpresentation. We examined rates of cesarean delivery for malpresentation and compared outcomes between cesarean and vaginal delivery by region. RESULTS: Across all regions, stillbirth and neonatal mortality rates were higher among deliveries with malpresentation. In adjusted analysis, malpresentation was significantly associated with stillbirth (adjusted relative risk [aRR] 4.0, 95% confidence interval [CI] 3.7-4.5) and neonatal mortality (aRR 2.3, 95% CI 2.1-2.6). Women with deliveries complicated by malpresentation had higher rates of morbidity and mortality. Rates of cesarean delivery for malpresentation ranged from 27% to 87% among regions. Compared with cesarean delivery, vaginal delivery for malpresentation was associated with increased maternal risk, especially postpartum hemorrhage (aRR 5.0, 95% CI; 3.6-7.1). CONCLUSIONS: In a cohort of deliveries in low- and middle-income countries, malpresentation was associated with increased perinatal and maternal risk. Further research is needed to determine the best management of these pregnancies.

Sonographic assessment of fetal occiput position during labor for the prediction of labor dystocia and perinatal outcomes.

OBJECTIVES: To evaluate the effect of the occiput posterior (OP) position on dystocia and perinatal outcomes. METHODS: This was a prospective cohort study of 162 primiparous women. We performed intrapartum sonography, and fetal occiput positions were recorded. The relationships between the position of the occiput and the course of labor and perinatal outcomes were investigated. Statistical analysis was performed using SAS 9.2. RESULTS: Fifty-six of 162 fetuses were found to be in the OP position during the first stage of labor. Eight (80.0%) of 10 fetuses in the OP position during the second stage were among the 56 that were in OP position during the first stage. The rate of cesarean sections performed in the OP position group during the first stage was significantly higher than the rate in the non-OP position group (37.5% versus 8.5%, p < 0.0001). The duration of the second stage of labor was longer and neonatal complications occurred more frequently in the OP position group during the second stage than in the non-OP position group (77.9 ± 33.4 min versus 52.2 ± 26.6 min, p = 0.0104; 50.0% versus 17.2%, p = 0.0118). CONCLUSIONS: The OP position may be a useful predicator for labor dystocia that can lead to poor neonatal outcomes.

WHO recommendations for augmentation of labour / Recomendaciones de la OMS para la conducción del trabajo de parto

Optimizing outcomes for women in labour at the global level requires evidence-based guidance of health workers to improve care through appropriate patient selection and use of effective interventions. In this regard, WHO published recommendations for induction of labour in 2011. The goal of the present guideline is to consolidate the guidance for effective interventions that are needed to reduce the global burden of prolonged labour and its consequences. The primary target audience includes health professionals responsible for developing national and local health protocols and policies, as well as obstetricians, midwives, nurses, general medical practitioners, managers of maternal and child health programmes, and public health policy-makers in all settings.

Para optimizar los resultados de las mujeres en el trabajo de parto a nivel mundial se necesita una orientación basada en la evidencia que permita a los trabajadores de la salud mejorar la atención seleccionando bien a las pacientes y usando intervenciones efectivas. En este sentido, la Organización Mundial de la Salud (OMS) publicó recomendaciones para la inducción del trabajo de parto en 2011. La meta de esta guía es consolidar la guía para las intervenciones efectivas que se necesitan para reducir la carga del trabajo de parto prolongado y sus consecuencias. El público objetivo primario incluye profesionales de la salud a cargo de desarrollar los protocolos y políticas nacionales y locales, así como obstetras, parteras, enfermeras, médicos generales, administradores de programas de salud materno neonatal, y diseñadores de políticas en todos los entornos.

The analysis reasons of cesarean section in primiparae without operation indications / 重庆医学

Objective To analyze the reasons of cesarean section in primiparae without operation indications ,in order to provide foundation for reducing the rate of cesarean section .Methods 640 cases of primipara were randomly divided into cesarean section with no operation indications(observation group) and spontaneous labor group(control group) ,320 cases in each each .The general data was investigated and analyzed ,the scale of cesarean section causes ,scale of cesarean section and pregnancy knowledge were compared between the two groups .Results The average age of the observation group was significant higher than that of the control group ,the percentage of monthly income of over 2 000 yuan and the proportion of level of education for college or above was signifi-cant higher than that of the observation group(P<0 .05) .In terms of pain tolerance ,no confidence in the natural delivery ,timing production ,family members will ,elderly parturient women ,the observation group were significant higher than the control group (P<0 .05) .The pregnancy knowledge level of observation group was significant lower than the control group (P<0 .05) .Multi-fac-tor analysis showed that ,high education level ,no tolerence of pain ,no confidence in the natural delivery ,timing production ,elderly parturient women ,and low degree of knowledge during pregnancy were major cause of of cesarean section rate .Conclusion The ap-propriate analgesia and encourage should be adopted for pregnant women who can′t stand the pain ,without confidence in the natural delivery .Education should be strengthen for pregnant women who timing production ,elderly parturient women ,low degree of knowledge .

Clinical analysis on 220 cases of foetus of cephalic presentation umbilical cord around neck / 中国基层医药

ObjectiveTo study the influences of fetal umbilical cord around neck on foetus、newborn infants and the choices of delivery mode during delivery.Methods220 cases of cephalic delivery pregnant women with fetus who had fetal umbilical cord around neck symptom and 220 cases of cephalic delivery pregnant women with fetus who didn't have fetal umbilical cord around neck symptom,were selected to make a contrast observation.ResultsThe foetus who had fetal umbilical cord around neck symptom had higher rate of fetal distress and neonatal asphyxia.The maternal cesarean section would be much higher,too.The rate is 18.5％,8.6％,49.6％ which were higher than the foetus who didn't have such kind of symptom,the rate is 5.4％,1.8 ％,26.4％ ( all P ＜ 0.05 ).The rate of fetal distress and neonatal asphyxia was proportional to the number of circles around neck.One circle around neck is 12.6％,1.4％ ;two circles around neck is 27.1％,17.0％ ;three and more than 3 circles around neck is 69.2％,53.8％.ConclusionWe should enhance perinatal B-mode ultrasonic examination and fetal monitoring circle around neck,pay close attention to the factor of umbilical cord around neck and select suitable delivery mode so that we can reduce the incidence of fetal distress and neonatal asphyxia.When B-mode ultrasonics displays that the number of the umbilical cord around the fetus' neck is three and more than 3 circles,the incidence of neonatal asphyxia is high and the cesarean section is the best choice under such circumstances.

Escolha da melhor via de parto para o feto prematuro em apresentação cefálica / Choice of the best mode of delivery for the preterm fetus in cephalic presentation

A prematuridade é um dos maiores problemas da obstetrícia contemporânea. Possui etiologia multifatorial e sua incidência se mantém elevada em todo o mundo apesar das propostas terapêuticas e assistenciais. A escolha da melhor via de parto para o nascituro pré-termo é um dos aspectos fundamentais para a obtenção de melhores resultados neonatais. O objetivo desta revisão foi avaliar a escolha da melhor via de parto para o feto prematuro em apresentação cefálica. Artigos observacionais e de revisão sistemática mostraram-se polêmicos, suferindo a necessidade de novos estudos com metodologia prospectiva. Concluímos que a cesariana não deve ser recomendada como estratégia benéfica rotineira para esses fetos com vistas a diminuir morbidade e mortalidade neonatais na ausência de outras indicações obstétricas para a realização do parto por via alta.

Prematuriry is one of the biggest problems of the contemporary obstetrics. It has multifactor etiology and its incidence remains high incidence all over the world despite proposals of assistance and therapeutics. Choosing the best mode of delivery for the premature infant is a fundamental aspect to reach the best neonatal results. The objective of this review was to evaluate the choice of the best mode of delivery for the preterm vertex fetuses. Observational articles and systematic reviews proved to be con troversial, suggesting the need for further studies using prospective methodology. We have come to the conclusion that cesarean section should not be recommended as routine beneficial strategy for these fetuses, aiming at reducing neonatal morbidity and mortality, in the absence of other obstetric indications for this mode of delivery.

Considerações sobre o parto na gestação gemelar diamniótica / Considerations of birth in diamniotic twin pregnancy

O manejo do parto gemelar é tema controverso em Ostetrícia. A via de parto ideal na gemelidade ainda não foi estabelecida. Até o presente momento, o parto vaginal deve ser considerado para cerca de 80 por cento das gestações gemelares diamnióticas, o que representa todos os casos em que o primeiro gêmeo está em apresentação cefálica. Dessa forma, o conhecimento das diversas peculiaridades do parto gemelar: duração da gravidez, indução e estimulação do parto, parto vaginal após cesariana, via de parto, intervalo de parto entre os gêmeos e conduta no segundo gemelar não cefálico...

Intrapartum management of twins is a controversal subject in Obstetrics. The optimal route of delivery of twins has not yet been established. Nowadays, vaginal delivery should be considered for almost 80 percent of diamniotic twin pregnancies, in other words, all cases in which the first twin presents in the vertex position. Thus, the knowledge of several issues of twin birth is essential for best practice. This paper reviews many aspects of twin pregnancy concerning birth management: pregnancy length, induction and augmentation of labor, vaginal birth after cesarean, mode of delivery, intertwin delivery interval and nonvertex second twin birth...

Comportamiento de la presentación podálica en la gestante primigrávida. Resultados perinatales / Behavior of podalic presentation in primigravid woman. Perinatal results

Con la finalidad de analizar el comportamiento de los resultados perinatales en la presentación podálica en gestante sin partos y con partos, se realizó una investigación retrospectiva, transversal y analítica en el Hospital Universitario "Abel Santamaría Cuadrado" entre mayo del 2001 y diciembre del 2002. El universo de estudio lo conformaron todos los nacimientos ocurridos en la etapa analizada, mientras que la muestra quedó constituida por todos los nacimientos ocurridos con presentación podálica; este grupo se dividió en dos: el grupo "A" formado por las gestantes que no tenían partos anteriores y el grupo "B" integrado por gestantes con partos anteriores. Se analizaron diferentes variables de la madre, el parto y el recién nacido. El análisis estadístico se realizó por el porciento, la media, la desviación estándar y para la comparación de los grupos se utilizó el test de Chi Cuadrado con nivel de significación de p < 0.05. Se obtuvo asociación entre las adolescentes con presentación podálica y el grupo "A" y entre las mujeres del intervalo de 30-34 años y el grupo "B". El peso del recién nacido, el Apgar y la morbilidad no resultaron significativas estadísticamente. Se concluye que los resultados perinatales en la presentación podálica son similares tanto para las gestantes como para las que han tenido embarazos anteriores.

In order to analyze the behaviour the perinatal results in podalic presentation in pregnants with delivery and without delivery, a retrospective, cross - sectional and analytic research was performed at Abel Santamaria University Hospital from May, 2001 and December, 2002. The universe in the study consisted of all births taking place during the analyzed period, whereas the sample comprised all births taking place with podalic presentation; this group was devided into two: group A which is formed by pregnants with no previous delivery and group B formed by pregnants with previous delivery. Defferent variates of the mother, delivery and new born were analyzed. The statistical analysis was performed by percent, mean, and standard deviation; and for comparing groups chi square test was used with a p <0.05 significance level. There was an association between adolescents with podalic presentation and group A, and between women raging from 30 to 34 years of age and group B. Post-term pregnancy was associated with previous deliveries; an association between caesarean section and group A, and eutocic delivery and group B was significant. The newborn´s weight, Apgar and morbidity did not turn out to be statistically significant. As a conclusion, perinatal results in the podalic presentation are similar both for primigravidas and for those women having previous deliveries.

Management of abnormal fetal heart rate in the second stage of labor / 中华妇产科杂志

Objective We investigated the correlations between abnormal fetal heart rate (FHR) during the second stage of labor and delivery types and intrapartum maternal complications and fetal outcome Methods The data of 232 nulliparas with single vertex in the second stage of labor (111 cases with normal FHR, 121 cases with abnormal FHR) were analyzed retrospectively Results The incidence of abnormal FHR in the second stage of labor was 52 2%(121/232) The patterns of abnormal FHR included: 81 (66 9%) cases with moderate and/or severe variable deceleration (VD), 27 (22 3%) cases with scattered late deceleration (LD), only one with continuous LD, 4 (3 3%) cases prolonged deceleration (PD), 2 (1 7%) cases with VD and LD, 3 (2 5%) cases with VD and PD, 4 (3 3%) cases with diminished baseline variability There were 13 (11 7%) among the cases with normal FHR and 35 (28 9%) among the cases with abnormal FHR underwent assistant delivery operations (forceps or/and vaccum), respectively ( P

Study on effect of delivery way on thyrotropin levels in pregnant women and their newborns / 中华妇产科杂志

Objective To investigate the effect on thyrotropin (TSH) levels of pregnant women and their newborns in different delivery ways. Methods The serum TSH levels of 213 pregnant women and the umbilical cord blood TSH levels of their newborns (140 cases from normal vaginal delivery, 38 cases from cesarean section, 35 cases from low forceps delivery) were tested by immunoradiometric assay. Urinary iodine was detected from pregnant women before delivery. Results In pregnant women, the mean serum level of TSH in the forceps group [(4 13?0 69) mU/L] was significantly higher than those of the normal birth group [(2 58?0 87) mU/L, P